Early Experience with Robotic Pancreatic Resections: a Retrospective Cohort Study of 20 Consecutive Cases.

Abstract

Background: Robotic pancreatic surgery has emerged as a minimally invasive alternative to open procedures, offering potential benefits in precision and recovery. This study evaluates the feasibility, safety and learning curve of robotic duodenopancreatectomy (RDP) and robotic distal splenopancreatectomy (RDSP) during the initial phase of implementation at a single institution.

Methods: A retrospective analysis of 20 consecutive patients, who underwent RDP (n=12) or RDSP (n=8) between January 2020 and December 2022, was performed. Data on operative time, intraoperative blood loss, conversion rates, postoperative complications (classified by Clavien-Dindo and ISGPS criteria) and length of hospital stay (LOS) were collected. Early (first six RDPs and four RDSPs) and late cases were compared to assess progression along the learning curve. Statistical analysis included Mann-Whitney U and Fisher's exact tests.

Results: The median operative time for RDP decreased from 480 minutes [interquartile range (IQR) 420-540] in early cases to 390 minutes (IQR 360-420) in later cases (p=0.03). The operative time for RDSP remained stable at 300 minutes (IQR 240-360; p=0.12). Intraoperative blood loss was 200 mL (IQR 100-400) for RDP and 150 mL (IQR 50-300) for RDSP. Two RDP cases (16.7%) required conversion to open surgery due to vascular adhesions. Postoperative complications included pancreatic fistula in 20% of cases, delayed gastric emptying in 15% of cases and major complications (Clavien-Dindo ≥III) in 25% of cases. The median LOS was 10 days (IQR 8-18) for RDP and seven days (IQR 5-10) for RDSP. No 90-day mortality was observed.

Conclusions: Robotic pancreatic resections are feasible and safe during the early learning curve, with morbidity comparable to open surgery. Operative efficiency improved significantly for RDP, highlighting the importance of structured training and case volume. These findings support the adoption of robotic techniques in pancreatic surgery, though further studies are needed to validate long-term outcomes.